[Question #7057] unprotected sex with CSW in UK

10 months ago
Dear doctor

I am 30, male, uncircumcised.  I am healthy and practice sport.  On a drunken night last week, on 28th June 2020 I had a sexual encounter with a CSW in UK, Nottingham.  I had unprotected oral (both ways) and vaginal sex with her for around 3 hours.  We had penetrative sex 3 times, each lasting 30 minutes or so, and I ejaculated inside her.  She had out brought condoms but we bonded well and we talked and one thing led to another we ended up having unprotected sex.  She is 35 years old and has 3 children.  She lived in Malaga Spain before coming to UK last year.  

We shared a lot of things and talked and she told me she never did sex without condoms with any other client.  She also said she tested for HIV around March and was negative.   She said she has no health problems, does not take any drugs though she smoked weed a couple of times and did a line of coke once long ago.  She looked healthy and clean.  She was lean, her breasts were a little bit sagging but she bore no visible marks of needles or unhealthiness.  She was clean and well-spoken.

She has since this week left UK to go back to spain and I cannot get in touch with her at all.  I am very worried as to my health and STD status.   I have no symptoms but I am very worried.  I had shaved around 3 hours before sex and a day before, on Saturday 27th June I had two pubic area wart frozen (cryotherapy).   I had gotten warts from a past relationship last year and was on cryotherapy treatment.

What is my risk for HIV and STDs?  When should I get tested and for which STIs?  This is my one and only sexual encounter that I paid for.

I am really worried.  Please help.  My last test was in March this year and I was negative (after my last relationship and sex).  I had sex first time again after March.

I am really ashamed and feeling guilty now.
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago

Welcome to the Forum.   Thanks for your question.  I'll be glad to comment.  With any new partner there is always a small risk that they might have an STI which could be transmitted.  The STIs most commonly transmitted are chlamydia and, at a lower rate gonorrhea.  HIV infections are uncommon among female CSWs. and transmission occurs on average only about once in  every 1200 genital exposures and even more rarely with oral sex  Your partner's profession and your description of her suggest that while she certainly has had other partners, she sometimes uses condoms and does get check regularly, reducing the likelihood that she was infected.  Further, even if a partner is infected, with any single exposure, it is unlikely that the infection will be transmitted.  Multiple exposures, as you describe increase your risk for infection if your partner did have an STI. 

Thus there is some risk associated with this exposure and it is probably worthwhile for you to seek testing for the most common STIs, both for your peace of mind and to completely rule out the modest chance that you were infected.  At this time, 5 days after your exposures, urine and throat tests for gonorrhea and chlamydia will provide reliable results.  If you wish to be quite thorough, you could also have your urine tested for trichomonas and perhaps Mycoplasma genitalium which is routinely checked for in the UK but not the U.S.  Your risk for both HIV and syphilis is low and it is too early to test.  Blood tests for these infections (syphilis and HIV) will be far more reliable 30 days after your exposure and conclusive at 6 weeks.  We would specifically recommend AGAINST blood tests for herpes as these tests are not recommended for your situation.

That you had shave recently and had cryotherapy for genital warts should not increase your risk for infection.

I hope this information is helpful.  If there are further questions or clarification is needed, please feel free to use your up to two follow-ups for that purpose.  EWH

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10 months ago
Thank you for your reply doctor.   I am scheduled for a test soon as lockdown is ending this week here.  As for HIV test, the NHS of UK is going to test me in 6 weeks for HIV and Syphillis.  Gonorrhea and other tests will be done during the weekdays next week.

Should I get tested at 30 days then 6 weeks or is one test at 30 days ok?   And also are the odds in my favour (given my 3 times sex in one night with the CSW girl) as I am really worried about HIV?

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago
You plan sounds good.   One test is sufficient, preferably at 6 weeks.  No need or benefit from testing at both 30 days and 6 weeks.

You risk for HIV is quite low.  There is a more than 99.9% chance that you DID NOT get HIV from the encounter you describe. Try not to worry.  EWH 
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10 months ago
Thank you very much Dr Hook for the great advice and clarifications.  Have a nice one ahead.  Cheers